牵张成骨联合正颌外科治疗成人严重小下颌畸形伴重度阻塞性睡眠呼吸暂停低通气综合征

目的:探讨牵张成骨术联合正颌外科的方法治疗小下颌畸形患者下颌骨严重发育不足伴重度睡眠呼吸暂停综合征(OSAHS)的效果。方法:对2例继发于颞下颌关节强直的小颌畸形患者首先采用牵张成骨技术进行治疗。手术在全麻下行双侧下颌角处截骨,安置牵引器,延长下颌升支及下颌体矫正小颌畸形及OSAHS。第二期在拆除牵引器的后行正畸治疗,继而采用正颌外科方法矫正颌面畸形及咬合关系,术后进一步正畸治疗矫正咬合关系排齐牙列。结果:2例患者均顺利完成治疗。下颌骨最小牵引距离25mm,最大牵引距离30mm,牵引区成骨良好。后气道间隙由治疗前的平均3.25mm增加到11.5mm;SNB角由术前平均67°增加到术后80°,OSAHS得以治愈。联合正颌外科及正畸治疗后小颌畸形得以矫治,面型及咬合功能均获得满意的效果。术后经过2年随访,未见复发。结论:牵张成骨技术联合正颌外科治疗成人严重小颌畸形伴重度OSAHS可以获得满意的效果。不仅可有效治疗伴发的OSAHS,而且能很好地矫治小下颌畸形引起的牙颌面畸形。

Distraction osteogenesis united with orthognathic surgery in correction of severe mandibular micrognathia accompanying obstructive sleep apnea -hypopnea syndrome

Objective To evaluate the effect of distraction osteogenesis united with orthognathic surgery in correction of mandibular micrognathia accompanying obstructive sleep apnea -hypopnea syndrome. Methods Two patients who suffered from obstructive sleep apnea -hypopnea syndrome caused by micromandibular deformity were treated by distraction osteogenesis and orthognathic surgery under general anesthesia.At the first stage,after osteotomy of mandibular body,the tractor was put on,the mandible was protruded so as to rectify micrognathism and obstructive sleep apnea - hypopnea syndrome.At the second stage,the tractor was removed,followed by an orthognathic operation for occlusal reconstruction. Results ALL the operations were performed as planned.The minimum distance of distraction was 25 mm,the maximum was 30 mm,in mandible of 2 patients with 4 sides.The distraction process was smooth in all the cases.The osteogenesis was good,without infection and other complications.The posterior airway space was increased from averaged 3.25mm preoperatively to 11.5ram.The increase of SNB angle was from preoperative 67 to 80 on average postoperatively.Micrognathism was rectified.The patients had their subjective symptoms disappeared completely.Thus the obstructive sleep apnea -hypopnea syndrome was cured. After the orthognathic operation,occlusion was reconstructed.The patient was significantly improved in the appearance,and satisfactory with the results.There was no recurence during a follow-up of 24 months after surgery. Conclusion Distraction osteogenesis united with orthognathic surgery can not only be used to effectively correct severe dento-maxillofacial deformities,but also can cure its accompanying OSAHS with hige curative rate,low relapse rate,and stable result.It is an /deal means to treat severe mandibular micrognathia with severe obstructive sleep apnea -hypopnea syndrome.